A resource for Filipino parents, their boys and all other Filipino males who need to be educated about the benefits of being uncircumcised, of foreskin restoration; the harm of getting cut and of learning how to live differently from the rest of the Filipinos.

Sunday, May 6, 2007

DR. RONALDO JOSON, MD

Question and Answer: Dr. Reynaldo Joson on Project Xtulepinoy2003

Why are you doing an advocacy against routine circumcision?

I want to save millions and generations of Filipino children from unnecessary circumcision, its pain and its risk of complications including death.

When did you start doing this advocacy and what initiated it?

At a personal level, in 1999, when I started realizing the senselessness of this practice. I started discouraging parents and colleagues.

In 2001, I completely stopped doing non-therapeutic circumcision, after I advised and convinced my son not to go for the tradition-driven circumcision. I felt I should not have double standards, i.e., not doing circumcision on my son and yet doing circumcision on patients other than my son. I remember vividly I turned down a request from a surgeon-colleague to do circumcision for his son on that year.

Publicly, in 2002, when I was the chairperson of the Department of Surgery of Ospital ng Maynila Medical Center, I received a letter of invitation from the Philippine Society of General Surgeons to conduct Operation Tule in Ospital ng Maynila Medical Center. I politely turned down the invitation and started an in-depth review of the issues of circumcision. Our department conducted a debate on pros and cons of circumcision and after which we decided to make a stand on NO to routine circumcision and NO to Operation Tule. Our department committed itself to spearhead an advocacy against tradition-driven circumcision as part of its social responsibility program.

Are you alone in this advocacy? If not, who are with you in this advocacy?

Initially, I was alone. Then, the Department of Surgery of OMMC was with me. Then, other surgeons and physicians all over the country joined us. Then, the whole hospital of OMMC supported us. OMMC is the first hospital in the Philippines that has openly declared its stand against tradition-driven and non-therapeutic circumcision.

I like to mention though, even before I was into my advocacy, there were already individuals who were into this advocacy already, like Dr. Michael Tan, the anthropologist, and Dr. Jaime Licauco, author of Inner Awareness.

What is/are your stand on circumcision?

We are for therapeutic circumcision such as in patients with phimosis (restrictive foreskin) with recurrent urinary tract infection, paraphimosis (too tight foreskin), and balanitis (infection of the glans penis).

We are against the performance of tradition-driven, non-therapeutic circumcision in children, both in the newborns and adolescents.

We are against the holding of Operation Tule, which promotes the performance of tradition-driven, non-therapeutic circumcision in adolescents.

We are not against the performance of circumcision on adult males who request it done for cosmetic reason.

Why are you against tradition-driven circumcision?

Primarily because it is non-therapeutic, that is, of no medical benefits, therefore, unnecessary. Doing an unnecessary circumcision inflicts on the subject, usually a male newborn or boy, unnecessary pain and unnecessary risk of complications which include the possibility or danger of death.

What is/are the origins and bases of the practice of circumcision?

The exact origins and bases of the practice of circumcision are not definitely known.

As to origins and bases of the practice of circumcision, these may be classified as religion-based or non-religion-based. Under religion-based origins, we have to study the how and why of its practice by the Christians, Muslims, and Jews. Under non-religion-based origins, we have to look at medical and non-medical reasons. Under medical reasons, we have to consider how circumcision can promote health and prevent disease. Under non-medical reasons, we have to look at the origin of the non-religious rituals.

What is the most common basis for the practice of circumcision in the Philippines?

As part of the non-medical non-religious rituals, as a rite of passage to manhood for the adolescent male children, as a result of fear of cultural stigma of being teased “supot”, as a result of peer pressure and as a result of the belief that all males should be circumcised with no specified reason. If there is a reason expressed by a parent, especially the mother, the reason is usually a myth, such as circumcision will make the boy cleaner, grow faster and taller.

Is the religion basis a strong justification or contributory factor for the rampant practice of circumcision in the Philippines?

NO. With majority of the Filipinos being Catholic and with the Catholic Church not requiring circumcision for salvation, the religion basis is not a strong contributory factor for the rampant practice of circumcision in the Philippines.

What are the evidences on the medical benefit of routine circumcision?

Using evidence-based medicine study approach, with analysis of almost 40 years of medical research on circumcision, the American Academy of Pediatrics in 1999 has come out with a stand that the benefits are not significant enough to recommend circumcision as a routine procedure.

Using number of patients needed to treat principle, routine circumcision is not warranted to prevent urinary tract infection and penile cancer. Urinary tract infection secondary to phimosis and penile cancer are uncommon if not rare.

Using the benefit-risk ratio, an invasive and painful procedure such as circumcision is not warranted to promote hygiene of the penis and to prevent diseases such as sexually transmitted diseases and cervical cancer. There are equally effective, non-invasive and painless procedures available such as meticulous mechanical cleaning, hygienic sexual practice, avoidance of multiple partners and sexual promiscuity.

Thus, for the above reasons, routine or tradition-driven, non-therapeutic circumcision is not indicated.

Is there such a thing as “painless circumcision”?

NO. Circumcision, just like any operative procedure which involves cutting of body tissues, entails some degree of pain, both during and after the operation.Considering that there are NO strong religious and medical reasons and considering the procedure is NOT without pain and complications, how do you intend to reduce if not stop the tradition-driven non-therapeutic circumcision in the Philippines?To reduce the tradition-driven non-therapeutic circumcision in the Philippines is to change the tradition and the peer pressure.The challenge really consists of three aspects. One is how to change the belief of parents who will have their male children undergo routine circumcision because of the tradition. Two is how to reduce, if not abolish the peer pressure that will make the male adolescents and adults undergo routine circumcision. Three is how to convince physicians to stop doing routine circumcision, especially those who have already acquired the habit of doing the procedure left and right and those who tend to ride on all traditions to avoid any conflict.What do I propose to do to meet the challenges? Basically, public health education and advocacy.Public health education will consist essentially of sending the message to the public through all forms of media that "TULE – HINDI NA KAILANGAN! MASAKIT PA!"Advocacy will consist essentially of actively campaigning against routine male circumcision by first explaining the issues and then convincing the public, especially the parents and male children that TULE – HINDI NA KAILANGAN! MASAKIT PA! Hopefully, with the advocacy, the belief and behavior will change and peer pressure removed.To meet the third challenge, which constitutes the physicians, advocacy will also consist of enlightening and convincing the physicians on the non-necessity of routine circumcision.The strongest strategy in the advocacy is for the physicians to speak out against routine circumcision. The public considers the physicians as the professionals to turn to when it comes to issues on circumcision. The public still has high respect for physicians in the Philippines.What have you done so far? How successful are you now in your advocacy?A lot have been done already but there is still a lot to be done. We need your help and all the help from every Filipino parents and physicians.We have done a lot of information dissemination since April, 2002, in the newspapers, radio, and television, health magazines, Internet, and public forums. We have created a website for this purpose: http://xtulepinoy.tripod.com/We have written to practically all medical associations and the Department of Health to get their stand. We are still awaiting their stand.We have enlightened and convinced organizations who have sponsored Operation Tule before not to do it anymore and do something else like cleft lip and palate mission and thyroid mission.Our end-points in this advocacy are: less if not zero routine circumcision in adolescent boys, less if not zero routine neonatal circumcision, and, less if not zero Operation Tule, At the moment, we don’t have the figures, both baseline and ongoing. It is not easy to get figures on these parameters.

At present, we measure the degree of success just in terms of concrete achievements or events, such as the following:

Presence of a manifesto of surgeons against routine circumcision (January, 2003)Presence of several medical departments and institutions against routine circumcision and have stopped holding Operation Tule (OMMC, PGH, JRMH, PCMC, ZCMC)

Presence of several organizations that have stopped sponsoring Operation Tule (REACT, Metrobank Foundation)

Number of parents convinced not to go for routine circumcision for their children. (about 1,000 as of March, 2003)

Presence of school physicians who came out with circulars on the pros and cons of circumcision to their students and parents (Xavier School)

What is your appeal for the parents, boys, and physicians in your advocacy?

For the parents,

TULE – HINDI NA KAILANGAN! MASAKIT PA!

Do not hurt your boys anymore.

For the boys,

TULE – HINDI NA KAILANGAN! MASAKIT PA!

Huwag madadala sa tukso!

For the physicians,

TULE – HINDI NA KAILANGAN!

Do not hurt the Filipino children anymore! PRIMUM NON NOCERE!

Continuing doing tradition-driven circumcision puts you at risk of a malpractice suit because of violation of bioethical principles and human rights of children.

2 comments:

I remembered being teased for being supot when I was younger with the fallacies that surrounded it. Believe me I have circumcised peers but they're not any braver, I have a circumcised cousin is still afraid of blood (and it's always been his weakness) and not to mention, my arch-rival is circumcised but he never grew any taller nor did any of those shorter guys who were circumcised.

There is a motion which accompanies uncircumcised males while he is penetrating a female. This motion equates to heightened pleasure for the female and male both. I say this as a female who has had intercourse with both. It is much more pleasurable with uncircumcised and to be really frank -I experienced the most mindblowing vaginal orgasms every time with uncirucmcised because of this particular motion inside and this never happened with circumcised partner--(same position woman on top with similar sized penis) these orgasms were definitely due to the motion of his foreskin. Do not cut off a part of a man or woman that is theirs and God given. If so many countries do not circumcise without negative impacts it should say something. It is a barbaric and cruel practice. I can see how it can be mis perceived that the unwrapped banana must provide more pleasure but the fact of the matter is in this situation: the banana skin really does contain thousands of nerve endings and contributes to the whole of the sexual experience for the man - imagine the banana peel moving back and forth. Get it? motion motion motion that does not exist for circumised males. Even masturbating for men is more pleasurable because there is so much more skin and motion. How else to explain. I hope I covered enough from both angles. Ask as many females they will say the same thing. In old testament ideology so to speak the practice was initiated literally to prevent sexual pleasure and to make men more "theology minded". It has had a reverse effect in my opinion because the men are never completely satisfied nor the women and this in effect creates an unfulfillment which in turn translates to seeking out more sex partners or other abnormal tendencies maybe even violent ones. Sexual pleasure is a gift and not one to be taken lightly as well the anatomy God gave you. By decreasing male or female sexual pleasure, you are really doing alot of damage whether psychological or physical. Luckily, the circumcised males do not know what they are missing out on- though in my opinion they are nowhere near as fulfilled but just don't know it (in same way I was never fulfilled with circumcised but did not know it until I was with uncircumcised) they can't know unless they talk to an uncircumcised male and attempt to understand fully: the role of the foreskin, the sensitivity of the nerve endings in it, and the motion it creates while it sits on the penis and when it is touched and how it completely alters the sexual experience (motion)- all of these things are very paramount in his pleasure and hers.

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THE PAINFUL PASSAGE

SEE CIRCUMCISION MAP AT BOTTOM OF PAGE

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Circumcision

"I always see more problems from a circumcision than from a foreskin."
- a paediatrician, quoted on America On Line.

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Prejudice in the Philippines

One way circumcision is perpetuated is by prejudice against intact men. Some men get themselves circumcised in order to escape this prejudice.Others have their sons cut to protect them from it. Both ways are evasions, not solutions. Like hair-straightening and skin bleaching by Black people, they are defeatist and demoralising.

Amercian Doctors Opposing Circumcision

Foreskin protects

The perception that foreskin is unhygienic is a myth, says George C. Denniston, M.D., president of the Seattle-based Doctors Opposing Circumcision. “Foreskin protects against disease; it doesn’t cause disease. If foreskin is unhygienic, eyelids should be considered unhygienic.”

David by Michaelangelo, 1504

famous uncircumcised sculpture

David by Michaelangelo

Up close

Deceived psyche

"The pressure to circumcise is said to be 'psychologically ingrained and culturally embedded in the collective psyche of Filipino women.' No wonder sometimes it's mothers who drag their sons, screaming and begging for mercy, to the chopper."

Prepuce for Sale

Since the 1980s, private hospitals have been involved in the business of supplying discarded foreskins to private bio-research laboratories and pharmaceutical companies who require human flesh as raw research material. They also supply foreskins to transnational corporations such as Advanced Tissue Sciences of San Diego, California, [1] Organogenesis, [2] and BioSurface Technology, [3] who have recently emerged to reap new corporate profits from the sale of marketable products made from harvested human foreskins. In 1996 alone, Advanced Tissue Sciences could boast of a healthy $663.9 million market capitalization performance.http://www.sexuallymutilatedchild.org/f4sale.htm

Criminal Code of Canada

According to the Criminal Code of Canada, circumcisers are guilty of committing assault and battery upon their patients.

Uncircumcised penis more attractive, protected, cleaner.

Exposed glans when in public (gyms, beach, onsen, etc. ) considered rude in many cultures.

LETTERS FROM THE EMAIL

Genital cutting practices vary widely in The Philippines.

Many guys are cut in hospitals by Western-trained doctors, but there is only one doctor per 10,000 Filipinos (vs about 1 doctor per 500 Americans). Most traditionally "circumcised" Filipinos are actually supercised, which is to say the skin tube is drawn forward and a longitidinal slit is made in the top at the rollover point. The skin can then flop free of the glans but nothing has been amputated. Such a cut person will self-report that he has been circumcised.

Most genital cutting in The Philippines is in defiance of the Catholic church's official policy against it.

Shorter thrusts

Marilyn Milos cites a 1999 study published in the British Journal of Urology which documented that women were more likely to have an orgasm (and less likely to experience vaginal discomfort) with an uncircumcised partner. The study concluded that the uncircumcised penis glides within its sheath of moveable skin with minimal friction. Because of this, uncut men use shorter thrusts than cut partners, who drive more deeply to launch an orgasm. The shorter thrusts of uncircumcised men, according to 71 percent of the respondents, allowed more contact with the mons pubis and clitoris, creating more orgasms for the women.

SUPPORT THE NATL COALITION AGAINST CIRCUMCISION

Restore Yourself

Now, I dont believe a mistake was made when man was created, do you? Even if one doesn't believe in creation, nature just doesn't repeatedly make what doctors are considering to be faults in baby boys that must be fixed. I understand that those of the Jewish faith regularly circumcise the male child but according to what I have learned, they only remove a very small portion of the foreskin at the tip of the glans. Doctors in the U.S. remove the whole thing which is a lot of skin and amounts to approximately the size of a 3 x 5 inch index card in an adult male! Many times they accidentally remove even more skin than this and boys grow up with either painful erections or their erections are bent because the skin is stretched too tight. Both men and women usually believe that's just the way some penises look and never question it. There can be other complications also. Circumcised males grow up never knowing that they lost a natural function of the penis and lost a great amount of sexual pleasure.

LET'S GET CIVILISED

Male or female circumcision is the practice of surgically modifying the private part of the human being. This practice, in one form or the other, exists in many parts of the world, not least of all in Africa, and in particular, Nigeria. Female circumcision is negatively referred to as female genital mutilation. It is difficult to understand why male circumcision is not referred to in the same way. Some insight into this is necessary.

Most of us may not realise that male circumcision is NOT common in many parts of the world, particularly in the Western world. It may come as a shock to many to find that the average European man is uncircumcised. In fact, the hospitals in the UK, US and most other Western countries do not perform circumcision. It is considered an outdated religious practice. Should you require it for, say, a baby boy, you would have to seek out a Jewish rabbi or some other practitioners to have it done. The Jews are the only white group with a history of circumcision.

It must, therefore, be understood that the issue of circumcision, whether for male or for female, is completely outside the cultural practices (or understanding) of the Western world. They neither understand nor accept the practice. They are, therefore, not qualified to determine the expediency of the practice. Male circumcision is simply tolerated because the Bible speaks about it. Otherwise, we would have been faced with Western media onslaughts accompanied by local "let's get civilised" civil rights, NGO and other groups, trying to convince us that male circumcision is primitive, barbaric, reduces male sexuality, scars the organ and causes untold pain and suffering to the baby. That it risks permanent deformation and disability to the baby, or death through fatal infection. It is, therefore, totally unjustified and unjustifiable.

Our ancestors could even have been accused of circumcising to prevent male promiscuity! Statistics would be provided to show that uncircumcised men are more virile, and more fertile than the circumcised ones. Parents would be accused of violating the rights of their baby boys. Imagine then, the difficulty of trying to convince our "been-to" and Western-oriented elites that male circumcision representing hundreds of years of ancestral practice should only be changed with caution if at all, and then only when it is OBVIOUS to the people that the practice is dangerous, and has become unnecessary, having been overtaken by practices generally considered more advantageous to the people as a whole. Imagine a situation where there was a British or American law against male circumcision. Thank God for the Bible.

Some would say that female circumcision is not in the Bible but neither is wine-carrying, or church weddings - that does not make it wrong. Female circumcision is not synonymous with VVF as many groups have fraudulently implied. And the general conception that it is performed to reduce female sexual pleasure has been manipulated to inflame gender rights emotions. This was effectively shown a few years back in Lagos when, on an Igbo phone-in program, the presenter asked people to call in and air their views on the issue of female circumcision. The responses were enlightening. Not only were all the callers female and circumcised, each and every one of them insisted that she has or will circumcise any daughter of hers. None believed that her circumcision had affected her negatively, and all considered it a practice worth retaining.

The impression I got was that it was mainly the uncircumcised (and many opportunistic NGOs) that had a grouse with the practice. My reflection on the issue led me to wonder -- what would the Western advocates of human rights abuse think of this? Whether right or wrong, the facts remain. Like the response of the nurse shows, many girls have a clitoris which extends outside the vagina. Discussions with these girls will tell you that for such people, even the simple act of walking can be a serious turn-on. In this situation, how can anyone say that a well-performed circumcision will not be morally beneficial to the girl?

A critic may insist that this is the same as trying to stop promiscuity. If a mother helping her girl to manage sexual excesses as stated above is wrong, then taking her to a doctor to correct a malformed leg could also be wrong. Depending on your viewpoint (Western or Traditional) female circumcision may or may not be expedient at this point in our national development, but for God's sake, let us stop the foolishness of presuming that our ancestors were idiots who did things without reason, and who enjoyed the pain of the screaming baby. Mean old men who approved a practice fraught with risks for the baby and its parents (to whom the baby was considered precious). Thinking so would be the height of colonialism.

As the practice carries a risk of infection, deformation, bad scarring and other problems due to the way it is presently being handled, we can have qualified medical practitioners perform it as is done for males. We are then left with the matter of its social expediency.

At this point, I would advice that the choice remains with the parents until such a time when the practice is well researched and understood without Western bias by our own people, and in our own environment. I say this because I find that most NGO discussions refer to the worst forms of the practice, usually based on information from other parts of the world. Many parts of the world definitely perform circumcision very differently, both in content and in context. For some, it is just token, while for others, it is major surgery. Using inapplicable or exaggerated examples give rise to serious misinformation, with its attendant error of judgment. Is it right to throw away everything? The baby with the bath water? There are as many arguments for male circumcision as against it (Europeans and Moslems will tell you), and so it is for female circumcision.

As detailed earlier, all the arguments against female circumcision also apply to their male counterpart. The main difference is that well-trained doctors or birth attendants handle the boys. The common question is -Why female circumcision? My answer would be - Why male circumcision? We cannot even say we practice male circumcision because it is in the Bible since the practice predates the coming of Christianity, and the missionaries were probably NOT circumcised.

CLEARLY UNETHICAL

"Mothers demand it, doctors profit by it while babies cannot complain about it."

SMEGMA

A natural secretion of skin cells and oils that collects under the foreskin in both males and females. If allowed to grow stale, it may have a pungent aroma (commonly compared to cheese [males] or fish [females]), and has lubricant, pheromonal (sexual attractant) and perhaps bacteriostatic (bacteria-killing) functions. The quantity varies, but it is comparable to earwax. (In one survey, three out of 18 self-selected intact men never saw smegma; one saw it after a week unwashed; six after two days; eight after one day; and one after less than a day. Three out of sevencircumcised men reported seeing smegma.) (Gk. = soap)

What they say about their circumcision

Dr. Robert Landgraff circumcised me for no reason in Niles, Michigan in 1962. I was healthy and normal and he amputated a valuable body part. Sex feels dull as a result.

I hold culpable Dr. Landgraf and any doctor who was in a position to formulate a sane policy statement that should have discouraged warrantless surgery on unconsenting minors, and also the insurance company who paid for a destructive amputation.

uncircumcised.eu

Philippines

Around 98% of male children are circumcised in the Philippines, as it is a practice with established religious and cultural roots, and is also believed to be hygienic, but there is little evidence to affirm the association between circumcision status and optimal penile hygiene. Source: http://uncircumcised.eu

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